Mood Disorders

Question 1

Discuss epidemiology of mood disorders and disability, both world wide and in the United States.

Answer 1

mood disorders = 1/2 of all causes of disability worldwide
Depression affects approximately 120 million people worldwide
Anxiety disorders are the most common psychiatric illnesses

Question 2

Discuss common signs and symptoms of depression and criteria for diagnosis.

Answer 2

s/s = SIGECAPS
dx = must experience 5 or more symptoms that have persisted for 2 weeks or more, are a change from previous function, and patient experiences sad mood or
anhedonia

Question 3

Discuss common signs and symptoms of bipolar disorder and criteria for diagnosis.

Answer 3

mania = DIGFAST
manic mood and behavior (euphoria, grandiosity, pressured speech, impulsivity, excessive libido, recklessness, social intrusiveness, and diminished need for sleep,
• dysphoric mood and behavior (depression, anxiety, irritability, hostility, and violence or suicide)
• psychosis (delusions and hallucinations)
• cognitive symptoms (racing thoughts, distractibility, disorganization, and inattentiveness).
Diagnosis of mania is made when patients suffer from a particular number of symptoms over
time. Specifically, patients must experience A distinct period of abnormally & persistently
elevated, expansive or irritable mood, and persistently increased goal-directed activity or
energy, present most of the day nearly every day lasting at least 1 week (or any duration if
hospitalization necessary), plus 3 or more symptoms (if euphoric), or 4 or more symptoms (if
irritable).

Question 4

Discuss atypical depression.

Answer 4

Atypical: mood reactivity, leaden paralysis, reverse neurovegetative symptoms (increased appetite, weight gain, hypersomnia)

Question 5

Discuss subcategorization of bipolar disorder (bipolar I and II disorder).

Answer 5

extreme mood swings to cyclothymia to hypomanias + major depression (Bipolar II) to frank manias (Bipolar I).

Question 6

Discuss differential diagnosis of mood disorders.

Answer 6

medical illness
substance abuse
medication SEs
personality
mood disorder

Question 7

Discuss current theories concerning etiology and pathophysiology of major depression.

Answer 7

Depression is highly recurrent. Lifetime risk after 1 episode is 50%, after 2 episodes is 60-70% and 90% after 3 or more episodes.
Activation of the HPA axis to stress is well-known.
• Neurons in the paraventricular nucleus of the hypothalamus secrete corticotropin-releasing
factor (DRF) which stimulates the synthesis and release of adrenocorticotropin (ACTH) from
the anterior pituitary.
• ACTH then stimulates synthesis and release of glucocorticoids (cortisol) from the adrenal
cortex. These exert profound effects on general metabolism and affect behavior.
• The activity of the HPA is controlled by several brain pathways ,including the hippocampus
(exerts inhibitory influence) and the amygdala (which exerts a direct excitatory influence).
• However, sustained elevations of glucocorticoids, as when under severe and prolonged
stress, may damage hippocampal neurons. This may involve a reduction in dendritic
branching and loss of dendritic spines, where the neurons receive their glutamatergic
synaptic inputs.
• The inhibitory control that the hippocampus exerts on the HPA axis is diminished, resulting
in a further increase in circulating glucocorticoid levels. Ultimately, this may result in
hippocampal atrophy seen in some, but not all depressed patients.

Question 8

Discuss current theories concerning etiology and pathophysiology of bipolar disorder.

Answer 8

There is no clear etiology of bipolar disorder, and is likely the complex interaction between a number of genes, other neurobiological vulnerabilities, environment, stress, possible white matter abnormalities.

Question 9

Discuss risk factors for suicide, demographics, epidemiology.

Answer 9

1.4% all deaths in US and the 11th leading cause of death all ages
• 2nd leading cause of death 25-34 year olds
• In the US, ~ 300,000 attempts and 33,000 completed suicides per year.
• 10-15% of patients with severe MDD suicide
• 4:1 Male:Female suicide ratio
• 79 % of those who commit suicides are men
• Women attempt suicide 2-3X more often than men
• 2/3 of all completers had contact with PCP within a month of their suicide
• 56-75% of first attempts end in death
• 3-7% of all attempters will eventually kill themselves

Question 10

Discuss psychotic depression.

Answer 10

depression with auditory hallucinations, nihilistic delusions

Question 11

Discuss melancholic depression.

Answer 11

Melancholic: mood worse in the morning, early morning awakening, anorexia, weight loss,
guilt, psychomotor retardation.

Question 12

Dx:

mood worse in the morning, early morning awakening, anorexia, weight loss, guilt, psychomotor retardation.

Answer 12

melancholic depression

Question 13

Dx:

depression with auditory hallucinations, nihilistic delusions

Answer 13

psychotic depression

Question 14

Dx?

Mood typically worsens in the fall and winter, improves in the spring and summer.

Answer 14

Seasonal Affective Disorder

Question 15

What is Seasonal Affective Disorder?

Answer 15

type of depression- mood typically worsens in the fall and winter, improves in the spring and summer.

Question 16

Dx:

extreme mood swings to cyclothymia to hypomanias + major depression (Bipolar II) to frank manias (Bipolar I).

Answer 16

bipolar disorder